Cannabinoids: THC and CBD
There are many different cannabinoids in cannabis, but the two main cannabinoids of interest in the medicinal context are Cannabidiol (CBD) and tetrahydrocannabinol (THC).
THC is the main psychoactive compound found in cannabis, whereas CBD causes no psychoactive effects. Products vary in their ratios of cannabinoids, with formulations generally containing predominantly CBD, predominantly THC or a specified ratio of both.
Some whole-plant extract products aim to keep the ratio of cannabinoids and active ingredients exactly the same as what is found in the cannabis strain itself. By retaining the minor cannabinoids, terpenes and flavonoids alongside the THC and CBD, it’s hypothesised these other ingredients can modulate the effects of the THC and CBD. This is known as the “entourage effect,” and it’s theorized to produce better health outcomes when compared with products containing a single isolated compound.
Forms of medicinal cannabis administration
The two most common ways to administer medicinal cannabis are by sublingual administration of oil extracts or inhalation (vaporisation) of dried flower.
The two methods have different timings for onset and duration of action. Generally, vaporising of dried flowers is used for immediate relief of symptoms and oils are used for a baseline reduction in symptoms. This is because ingestion has a longer (six to eight hours) but less intense period of efficacy compared with inhalation (two to four hours), though this varies with individual metabolic differences.
Smoking cannabis is not supported as a viable method of administration for medicinal cannabis. Smoking in general is harmful and in the process of doing so much of the cannabinoid content can be lost, making specific dosing difficult to control.
When cannabis is inhaled, cannabinoids are absorbed from the lungs into the bloodstream within minutes. From there, the cannabinoids are transported to the brain where their concentration peaks within 15 minutes. This time frame correlates with the peak psychological and physiological effects experienced by patients.
The specific effects may vary between individuals based on factors including heating of the cannabis, number of inhalations, time between inhalations, the inhalation period and lung capacity.
Products designed for inhalation are often produced from plants with laboratory tested and predictable cannabinoid content. A vaporising device can be obtained for patients through the unapproved medical device access pathways, which is part of the Special Access Scheme (SAS) pathway.
It should be noted that SAS approval of a medicinal cannabis product requiring inhalation is conditional on use with an appropriate medical device.
When consumed orally, cannabinoids are absorbed from the digestive system into the bloodstream. This method of absorption is slower and more unpredictable than inhalation. As such, onset of action can take 60 to 180 minutes with the maximum effects experienced between two and three hours after ingestion.
Sublingual administration is similar to oral administration but involves a different primary method of absorption. Instead of swallowing the oil, patients take the prescribed quantity and hold it under their tongue as long as possible. There is a greater blood supply under the tongue, which therefore provides better absorption and efficacy of effects.
Oils are made by extracting cannabinoids from cannabis plant material, often using CO2 or ethanol. The oil is typically swallowed or put under the tongue using a dropper. Oils can also be put into capsules for swallowing like any other pill.
By retaining the minor cannabinoids, terpenes and flavonoids alongside the THC and CBD, it’s hypothesised these other ingredients can modulate the effects of the THC and CBD
Titration is the process of gradually increasing the intake of medicinal cannabis until a desired dose is achieved. It’s recommended when beginning medicinal cannabis therapy to start low and go slow. Patients should not ingest additional cannabis until they have accurately gauged the effect of their prior dose. Taking too much cannabis can cause discomfort and should be avoided. Finding the right titration point will take time and clear communication with the patient.
- Start dosing in the evening and separate doses by at least six hours.
- Maintain a consistent dosing schedule and increments.
- Gradually increase the quantity (if needed) until the optimal dose is found.
- Adjust dose timing accordingly based on the severity the of symptoms.
- Some patients prefer to take smaller doses at greater intervals.
Our online portal, Cannatrek Plus, is under development. Once complete, it will simplify the process of finding the right products, and managing dosing and titration schedules for patients. Cannatrek Plus will be able to recommend products based on the patient’s conditions and indications to assist you in prescribing effective treatments.To learn more about Cannatrek’s products and formulations, contact us for more information.